Implementation

Policy Components

Children 12 months and older attending full day program must participate in 60 minutes of physical activity per day

Children 3 years and older must participate in at least 30 minutes of structured and guided physical activity to meet the 60 minutes of total physical activity

Television, video, and visual recordings are not permitted for children under 2 years of age

Television, video, and visual recordings are limited to 60 minutes per day of educational programming for children 2 years or older

Food and Food Areas requirements:

Prohibit providing beverages with added sweeteners to children

Require water to be accessible and available for children to drink throughout the day

Limit quantity and provision of juice to one 6-oz serving per day

Limit fat content of milk to children age 2 and older to 1% or lower

Require distribution of nutrition guidelines to parents for food brought into day carem facilities from other sources

Informing Day Care Centers

Before the new regulations were enforced, child care directors were informed of the changes in three ways:

The Bureau of Child Care held one public meeting in each borough specifically for center directors to inform them about the amendments to Article 47. Senior staff from the Bureau led these sessions and answered questions from day care center staff about changes to the regulations.

Mailings were sent from the Bureaus of Child Care and Chronic Disease Prevention and Control to day care directors to inform them of new provisions included in Article 47 for both Nutrition services and Physical Activity (see Intervention Materials for copies of Nutrition and Physical Activity mailings).

The Nutrition mailing includes guidelines for meals, snacks, and beverages; recommendations for foods offered during special occasions; recommendations for infant feeding; daily calorie levels for children; and suggested portion sizes for meals and snacks.

The Physical Activity mailing includes overall physical activity guidelines for children ages 3 to 5 and structured physical activity guidelines for children ages 3 to 5.

Bureau of Child Care staff who regularly visit day care centers (including Early Childhood Educational Consultants (ECECs) and sanitarians) were informed of the changes to Article 47 and were asked to inform day care directors about them when visiting centers. In addition, ECECs and sanitarians encouraged day care centers to participate in trainings offered by the Bureau of Chronic Disease Prevention & Control that would support compliance of the regulations (details below).

Programs that Support Policy Implementation

In order to support compliance, the Bureau of Chronic Disease Prevention and Control offers technical assistance to day care centers through the Move-To-ImproveEarly Childhood and the Eat Well, Play Hard Programs.

Eat Well Play Hard – Nutrition component

The Eat Well Play Hardnutrition program works with day care centers in neighborhoods with the highest rates of childhood obesity. It uses an innovative, hands-on curriculum to educate children, parents and center staff on healthy eating habits. The program reinforces the nutrition components of Article 47. The Eat Well Play Hard program is funded by New York State Department of Health through the USDA Supplemental Nutrition Assistance Program Education (SNAP-Ed). SNAP-Ed support includes the development and dissemination of nutrition education messages. As of August 2010, approximately 302 day care centers have been trained in Eat Well Play Hard.

Move-To-Improve Early Childhood – Physical Activity component

In order to support compliance with the physical activity component of the policy, the DOHMH provides a free training for day care staff on a structured physical activity curriculum called Move-To-Improve Early Childhood (See Intervention Materials). In this workshop, educators learn how to lead children in guided physical activity. Play equipment is also provided to trained staff. Since its inception, the program model has changed in two important ways. First, DOHMH initially used the SPARK! Early Childhood curriculum to train staff. This was replaced with the DOHMH-designed curriculum called Move-To-Improve. Second, just after regulations were passed, additional on-site technical assistance was provided to centers in the neighborhoods with the highest rates of childhood obesity. This part of the program ended because all sites within those neighborhoods had been visited on several occasions; however, the DOHMH continues to provide ongoing training to all day care centers. Approximately 15,000 day care staff and 80% of day care centers have been trained and equipped by this program.

Notably, compliance with Article 47 does not require participation in either the Move-To-Improve or the Eat Well Play Hard programs; however, both programs, support centers in their efforts to comply with Article 47.

Enforcement of the Policy

Enforcement of the regulations set forth by Article 47 is conducted through annual inspections by the ECECs and sanitarians, as part of the NYC Bureau of Child Care licensing regulations. During these inspections, ECECs look for compliance with the programmatic regulations (e.g., age-appropriate activities/games), while sanitarians focus on compliance with safety standards (e.g., playground safety, food safety), Both ECECs and sanitarians have the authority to enforce all policies. In order to determine compliance with the physical activity requirements, ECECs examine the day care center’s daily schedules to see if adequate time is allotted for movement. To assess compliance with nutrition regulations, sanitarians review menus and examine kitchens; however, enforcement of these regulations is challenging due to the lack of frequency with which inspections occur and the brief amount of time allotted for them. For example, sanitarians must assess compliance with all of Article 47 but cannot observe a full day in each classroom to observe whether center staff are providing not more than the daily limit of six ounces of juice per child.

Keys to Success

In New York City, the Board of Health regulates group day care centers; therefore, the DOHMH did not have to champion legislation that would normally have to go through elected officials to get passed. Instead, the DOHMH advocated for the changes via the Board of Health, a technical regulatory body that was already aware of the importance of addressing childhood obesity.

Enforcement of these policies is possible because the Bureau of Child Care had an existing protocol to visit and assess centers on an annual basis.

Centers located in areas with higher rates of health disparities are supported in their efforts to implement these policies by additional on-site training and technical assistance provided by the DOHMH.

At the time these regulations were proposed, there were champions for its amendments at multiple levels within the NYCDOHMH, including former Health Commissioner Frieden, and externally, including the City Council, Mayor Bloomberg, the public, and stakeholders. With the exception of one, all public comments provided during the mandatory public comment period1 were in support of the policy.

The Department had support from day care directors who believe that this policy is necessary to promote health in their centers.

The NYC food procurement standards require that all food purchased and meals served by ALL New York City agencies (including day cares funded by the City) are intended to “improve the health of all New Yorkers” served by these agencies. These standards restrict the inclusion of trans fats in any foods served; restrict the purchase of foods prepared by deep frying; and include sodium, calorie, fiber and fat guidelines depending on the food category. The fact that these standards exist establishes a cultural norm of promoting health among New York City agencies and in the city as a whole, thus increasing support for chronic disease and obesity prevention efforts.

The New York City Council recognized the importance of addressing childhood obesity and supported the legislation by providing funding for technical assistance. Without its support, the DOHMH would not have been able to provide training to demonstrate how to implement the physical activity regulations within day care centers.

Barriers to Implementation

It is challenging to enforce some of the policies as written. For example, the daily limit of six ounces of 100% juice is difficult for centers to implement if they serve meals family-style.

There is limited space for both indoor and outdoor play in NYC day cares, making compliance with physical activity requirements difficult.

There is some resistance among parents to comply with the nutrition regulations when sending foods to the day care for regular meals or celebrations.

Although there are few costs to day care centers to comply with the regulation, there are indirect costs to pay for staff to attend technical assistance trainings. While the actual training is free, day care centers incur costs to pay for substitute teachers to provide services to their clients during the trainings.

1 A public comment period in the form of public hearings was required following the publishing of the notice of intent to repeal and reenact Article 47 (Child Care Services) of the New York City Health Code in the City Record. Two public hearings were held.

The Center TRT is supported through Cooperative Agreement Number U48-DP001944 with the Prevention Research Center of the Centers for Disease Control and Prevention with funding from the Division of Nutrition, Physical Activity and Obesity.